Background: Few published studies have combined clinical prognostic fac tors into risk profiles that can be used to predict the likelihood of recurrence or metastatic progression in patients following treatment of prostate cancer. We developed a nomogram that allows prediction of disease recurrence through use of preoperative clinical factors for patients with clinically localized pros tate cancer who are candidates for treatment with a radical prostatec. Methods: By use of Cox propor tional hazards regression analysis, we modeled the clinical data and disease follow-up for 983 men with clinically localized prostate cancer whom we in tended to treat with a radical prosta tectomy. Clinical data included pre treatment serum prostate-specific antigen levels, biopsy Gleason scores, and clinical stage. Treatment failure was recorded when there was clinical evidence of disease recurrence, a rising serum prostate-specific antigen level (two measurements of 0.4 ngor greater and rising), or initiation of ad juvant therapy. Validation was peron a separate sample of 168 men, also from our institution. Results: Treatment failure (ie, cancer recur rence) was noted in 196 of the 983 men, and the patients without failure had a median follow-up of 30 months (range, 1-146 months). The 5-year probability of freedom from failure for the cohort was 73%(95% confidence interval= 69%-76%). The predictions from the nomogram appeared accurate and dis criminating, with a validation sample area under the receiver operating charcurve (ie, comparison of the predicted probability with the actual outcome) of 0.79. Conclusions: A nomogram has been developed that can be used to predict the 5-year probability of treatment failure among men with clinically localized prostate cancer treated with radical prostatectomy.[J Natl Cancer Inst 1998; 90: 766-71]

Clinically localized prostate cancer is most often treated with conservative management (ie, watchful waiting or hormone therapy)(1, 2), external beam irradiation (3, 4), or radical prostatectomy (5-8) and occasionally with therapeutic interventions such as interstitial radioactive seed implantation (9) or cryotherapy (10). Although several clinical trials are under way, no prospective randomized trials have been published that allow definitive comparison of cancer control rates among alternative treatments (11). Even when such trials are completed, all patients with a clinically localized cancer will not have an equal probability of a successful outcome. There are several established prognostic factors that can be used to predict the risk of recurrence after surgery or radiotherapy, or the risk of metastases or death from cancer after conservative management, including clinical stage (6, 12, 13), Gleason grade (2, 3, 14) and serum prostate-specific antigen (PSA) levels (3, 7, 13). Although these prognostic factors have been combined into a risk profile that can be used to predict the pathologic stage of the cancer (15), we are not aware of published studies that combine these standard clinical factors to predict the likelihood of recurrence or metastatic progression after treatment. We therefore developed a nomogram that predicts (before treatment) the probability of treatment failure, defined as a rising PSA level, following radical prostatectomy for clinically localized prostate cancer.

Materials and Methods

All 1055 patients admitted to The Methodist Hospital with the intent to treat their clinically localized prostate cancer (clinical stage T1-3a NX M0) with radical retropubic prostatectomy by a single surgeon during the period from June 1983 through December 1996 were potential candidates for this analysis. Each patient was assigned a clinical stage according …